The ACR was part of a 16-member collaboration that created a set of 21 principles on prior authorization and utilization management, intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other healthcare organizations support those principles. Now, the AMA has released the results of a new physician survey highlighting the significant negative consequences prior authorization (PA) has on patient access to care and treatment. Example: Medical practices complete an average of 29.1 PA requirements per physician per week, which takes an average of 14.6 hours to process—the equivalent of nearly two business days.
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Negative Impact on Timely Care
Anecdotes about the patient care delays and practice burdens caused by health plans’ onerous prior authorization (PA) requirements are common, but quantitative data to substantiate these stories have been limited until recently. Results from the new PA survey provide strong evidence of the significant impact this burdensome process can have on patients and physician practices. Results from the survey of 1,000 practicing physicians clearly show the negative effect that PA can have on timely patient care. Among surveyed physicians, 64% reported waiting at least one day for PA decisions from health plans, and 30% reported waiting at least three business days.
These wait times translate into patient care delays, with 92% of physicians saying that PA sometimes, often or always delays access to necessary care. These delays may have more serious implications for patients; 78% of physicians reported that PAs can lead to treatment abandonment. Moreover, an overwhelming majority (92%) of physicians indicated that PAs can have a negative impact on clinical outcomes.
The survey also addressed the burdens imposed on physicians and their staff by PAs. The survey results show that practices complete an average of 29.1 PAs per week per physician, with this PA workload requiring 14.6 hours—nearly two business days—of physician and staff time. Not surprisingly, 84% of physicians characterized PA-related burdens as high or extremely high. PA hassles have also been growing over time, with 86% of physicians reporting that PA burdens have increased over the past five years.
These data reinforce the need for strong advocacy efforts on PA reform. The AMA has undertaken a major campaign to urge health plans to right-size PA programs. In January 2017, the AMA, the ACR and a coalition of 16 other organizations representing physicians, hospitals, medical groups, pharmacists and patients released a set of 21 Prior Authorization and Utilization Management Reform Principles. These principles, which have been formally supported by more than 100 additional provider and patient groups, spurred conversations with health plans about the need for significant reform in PA programs.